[conspire] Numbers racket

[Rich Kulawiec]

On Wed, Apr 22, 2020 at 07:29:07AM -0700, Rick Moen wrote:

[an analysis that I largely concur with]

Let me augment it with the following, if I might.

1. We don't know how many people are (or have been) infected because
we don't have large scale testing.

2. We don't know how many otherwise-uncounted deaths recorded in the
past few months were caused by COVID-19 -- also because we don't have
large scale testing.

However: comparisons of seasonally-adjusted mortality rates show some
excess mortality in some areas even after known COVID-19 fatalities are
accounted for.  The most likely hypothesis is that those are probably
undiagnosed COVID-19 cases, e.g., people who died at home in New York
before they could be transported to a hospital and diagnosed.

3. To date, the US has conducted roughly 5 million tests.  We need
about 5 million tests per day.

	Roadmap to Pandemic Resilience | Harvard [PDF]
	https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20.pdf

	National Covid-19 Testing Action Plan - Rockefeller Foundation [PDF]
	https://www.rockefellerfoundation.org/wp-content/uploads/2020/04/TheRockefellerFoundation_WhitePaper_Covid19_4_22_2020.pdf

4. We also don't have reliable testing.

	There are three major problems with testing right now. One,
	we do not have the reagents. Our government is not working with
	private sector companies, as all the other governments of the
	world are now seeking testing to understand how to best ramp up
	these reagents that we do need. Number two is we have the wild,
	wild west for testing right now. The FDA has all but given
	up its oversight responsibility for the tests we have on the
	market. Many of them are nothing short of a disaster. And we got
	into that place because of the fact -- once CDC had a problem,
	the FDA just opened the gate. And we have a lot of bad tests on
	the market right now. The third thing is these tests just do not
	perform well in low prevalent populations. Meaning that right now,
	if you were to test for antibody in most places in the United
	States, over half of the tests would be false positives. So what
	we need is a major, new initiative on testing that gets away
	from every day just saying how many people got tested. We're
	missing the mark in a big way right now.

		--- Dr. Michael Osterholm, the director of the Center for
		Infectious Disease Research and Policy at the University
		of Minnesota, 4/26/2020 on "Meet the Press"


(1) (2) (3) (4) mean we need large-scale, reliable testing ASAP.


5. Focusing solely on mortality misses something important.  COVID-19 inflicts
damage in ways that seasonal flu does not.

E.g., some apparently-healthy relatively young people are dying from stroke:

	Young and middle-aged people, barely sick with covid-19, are dying of strokes
	https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/

E.g., an autopsy of a Santa Clara victim (believed to be the first US
fatality) showed that she suffered a massive heart attack:

	Exclusive: Coronavirus caused heart to rupture in nation's first known victim, autopsy shows
	https://www.sfchronicle.com/bayarea/article/Exclusive-Autopsy-report-of-first-known-15226422.php

E.g., David Lilienfeld has observed:

	As an epidemiologist, I'm amazed that the only thing that's
	discussed about Covid-19 and the lockdown is mortality. It's
	not just mortality, though.

	A 25% pulmonary function deficit that takes 15-20 years to heal,
	some sort of coagulopathy present in 1/3 of patients (long term
	implications not clear), neurological deficits (do you really
	think that only smell and taste are affected?).

	Joint inflammations (now being investigated), and liver
	damage--all of these aren't exactly appealing. Everyone talks
	about death--I think we physicians blew that one.

	We know that kids are infected. It seems relatively benign.
	Do they have any alterations in their neurobehavioral
	development? Growth?

	The comparison is oft made to the flu. The flu is not neurotoxic,
	and it isn't hepatoxic either. And while there are some pulmonary
	consequences, they're pretty rare.

	Talking about mortality with Covid-19 is like talking about the
	failure of Fannie Mae or AIG in 2008. Significant, but hardly
	the whole story.


6. The R0 for COVID-19 is being researched/debated but LANL has a paper out
estimating 5.7 as the median value. (Seasonal flu is about 1.3)

	High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 
	https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article

That paper says their 95% CI is 3.8 to 8.9, so even if they're wrong
enough that it's the lower bound of 3.8: that's still way more contagious.
(Keep in mind that it is R0^N that characterizes spread through a population.)

7. The concept of immunity (whether short-term, long-term, or permanent;
whether neutralizing or not; whether immediate or eventual) in the
context of COVID-19 is poorly understood at this time.

	What Immunity to COVID-19 Really Means - Scientific American
	https://www.scientificamerican.com/article/what-immunity-to-covid-19-really-means/

	"Immunity passports" in the context of COVID-19 | WHO
	https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19


Bottom line from (5) (6) (7): this isn't anything at all like seasonal flu.


8. I'm maintaining this page: http://www.firemountain.net/covid19.html
as a resource.  It includes links to tracking, primary data sources,
articles, papers, etc.  (It also links to a secondary page of news/analysis.)
I suggest reading all those articles and papers as a modest introduction --
I say "modest" because there is no doubt I've omitted or overlooked much
of what should be there.  It's a work-in-progress.

---rsk